Why HIV and hepatitis testing should be a national and international priority

The number of people living with HIV continues to rise in Eastern Europe and late diagnosis remains a major problem in the entire WHO European Region. Hepatitis B and C are common among people at risk for HIV infection, as the routes of transmission are very similar.

Effective treatment for HIV has been available in Europe since the mid-1990s and has led to a dramatic reduction in the incidence of AIDS events and HIV-related deaths. Many people are now living with HIV as a chronic condition rather than an inevitable fatal illness. However, of the 2.5 million people living with HIV in the WHO European Region, it is estimated that at least one in three are unaware of their HIV status – resulting in late diagnosis and continued transmission across the region.

Hepatitis treatment has improved in recent years and cure is now possible for 80-100% of people living with hepatitis C. However, approximately just 3.5% of people living with hepatitis C in Europe receive treatment, meaning many develop chronic hepatitis C which leads to many complications, such as liver cirrhosis and cancer.

In more recent years, HIV has become less of a priority in many European countries – in some instances there is little or no funding available for free, confidential HIV testing. If the availability of free and confidential HIV testing services is reduced, it may result in an increase in late diagnosis and onward transmission.

Hepatitis testing is vital for early diagnosis because people go without symptoms for a very long time, marking it a silent killer. Worldwide, infections with hepatitis B and C viruses cause an estimated 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer.

HIV and hepatitis testing programmes require government support and funding in order to achieve impact. Leadership is needed to:

Motivate and support government bodies at all levels

Provide incentives for widening the reach of voluntary and confidential testing programmes and ensure they are appropriately targeted

Overcome structural and attitudinal barriers

This website presents the evidence to support the benefits of scaling up access to and availability of HIV and hepatitis testing in order to support the rationale for why HIV and hepatitis testing should be priorities.

Testing and treatment guidelines and recommendations

Guidelines have been developed and published on a European level, which set out why and how HIV and hepatitis testing should take place across Europe. The guidelines also include data and evidence to support the need for HIV and hepatitis testing and treatment.

Evaluating local HIV and hepatitis testing initiatives

If you need guidance on how to assess HIV and hepatitis testing initiatives at a local level, you can refer to the ECDC guidelines or EASL guidelines on hepatitis B and C.

Specifically on page 15 of the ECDC guidelines, you will find details about how you can assess the success of local initiatives using the FACTS criteria (these criteria can also be applied to hepatitis testing activity):

Feasibility

Acceptability

Effectiveness and Cost-effectiveness

Target populations are reached

Sustainability

Toolkit 3 – HIV dossier of evidence: a summary of the evidence to support free, confidential and voluntary HIV testing

The dossier of evidence toolkit provides the rationale for free, confidential and voluntary HIV testing.

Examples of strategies and interventions to increase HIV and hepatitis testing are available in the Get involved section of the website.

Toolkit 3 – Hepatitis dossier of evidence: a summary of the evidence to support free, confidential and voluntary hepatitis testing

The dossier of evidence toolkit provides the rationale for free, confidential and voluntary hepatitis testing.

Examples of strategies and interventions to increase HIV and hepatitis testing are available in the Get involved section of the website.

Latest evidence on HIV and hepatitis testing and late diagnosis

For the latest evidence on HIV testing and late diagnosis visit HIV in Europe’s website: www.hiveurope.eu

For the latest evidence on hepatitis testing and late diagnosis please visit the following WHO websites:

Sponsorship statement: The EuroTEST initiative is governed by an independent steering committee. The Coordinating Centre is at CHIP, RegionH, Copenhagen, and the political secretariat at the EATG. The conditions of funding the initiative are approved by the Steering Committee. Industry sponsors are invited to quarterly updates but do not participate in the Steering Committee.

Financial support of the EuroTEST initiative provided by: Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Danish National Research Foundation (grant 126), European Commission under the 3rd and 2nd Health Programmes, European Centre for Disease Prevention and Control (ECDC), Gilead Sciences, GlaxoSmithKline, Merck, Pfizer, Schering-Plough, Swedish Research Council, ViiV Healthcare and Tibotec.

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